Hu A, Wang Z Y, Li Y, Tian J H, Guo Z M, Li Q L
Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, China.
Zhonghua Wai Ke Za Zhi. 2025 Jul 1;63(7):605-610. doi: 10.3760/cma.j.cn112139-20241104-00490.
To explore the reoperation cause and molecular classification of patients reoperated for papillary thyroid carcinoma (PTC). This is a retrospective case series study. Clinical data from 102 PTC patients who underwent reoperation at the Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center were collected between February 2019 and December 2024. The cohort comprised 26 males (25.5%) and 76 females (74.5%), with initial age of (33.1±12.2) years (range: 9 to 67 years). At initial surgery, 25.5% (26/102) exhibited extrathyroidal extension, 52.0% (53/102) had multifocal tumors, and 19.6% (20/102) had metastatic lymph nodes with extranodal extension. AJCC staging classified 95.1% (97/102) as stage Ⅰ, 2.9% (3/102) as stage Ⅱ, and 2.0% (2/102) as stage Ⅲ. Standardized primary tumor resection was performed in 81.4% (83/102), prophylactic central compartment lymph node dissection (LND) in 89.2% (91/102), and therapeutic lateral LND in 47.1% (48/102). Data on recurrence, genetic alterations, reoperation intervals, and clinical features of multiple recurrent PTC cases were analyzed. Among 102 patients, 81.4% (83/102) presented with lateral neck metastases, 48.0% (49/102) with central compartment metastases, and 22.6% (23/102) with residual thyroid lobe recurrence at reoperation. Reoperation occurred within 6 months postoperatively in 18.6% (19/102) and after 6 months in 81.4% (83/102). Genetic detection revealed mutation in 63.7% (65/102), fusions in 19.6% (20/102), and promoter mutations in 8.8% (9/102). During reoperation, 88.2% (90/102) underwent therapeutic lateral LND, and 39.2% (40/102) required residual gland resection. Twelve patients received multiple surgeries, including 4 cases with mutations, 4 with fusions, and 4 with mutation alone. The reasons for the reoperation of PTC mainly include recurrence and complementary surgery. Genetic alterations such as mutation and fusion are common in PTC patients requiring reoperation.
探讨甲状腺乳头状癌（PTC）再次手术患者的再次手术原因及分子分类。这是一项回顾性病例系列研究。收集了2019年2月至2024年12月期间在中山大学肿瘤防治中心头颈外科接受再次手术的102例PTC患者的临床资料。该队列包括26例男性（25.5%）和76例女性（74.5%），初始年龄为（33.1±12.2）岁（范围：9至67岁）。初次手术时，25.5%（26/102）表现为甲状腺外侵犯，52.0%（53/102）有多发肿瘤，19.6%（20/102）有伴有结外侵犯的转移性淋巴结。美国癌症联合委员会（AJCC）分期将95.1%（97/102）分为Ⅰ期，2.9%（3/102）分为Ⅱ期，2.0%（2/102）分为Ⅲ期。81.4%（83/102）进行了标准化的原发肿瘤切除，89.2%（91/102）进行了预防性中央区淋巴结清扫（LND），47.1%（48/102）进行了治疗性侧方LND。分析了多次复发PTC病例的复发、基因改变、再次手术间隔及临床特征数据。102例患者中，81.4%（83/102）在再次手术时出现侧颈转移，48.0%（49/102）出现中央区转移，22.6%（23/102）出现残留甲状腺叶复发。18.6%（19/102）在术后6个月内进行了再次手术，81.4%（83/102）在术后6个月后进行了再次手术。基因检测显示63.7%（65/102）存在突变，19.6%（20/102）存在融合，8.8%（9/102）存在启动子突变。再次手术时，88.2%（90/102）进行了治疗性侧方LND，39.2%（40/102）需要切除残留腺体。12例患者接受了多次手术，包括4例存在突变的患者、4例存在融合的患者和4例仅存在突变的患者。PTC再次手术的主要原因包括复发和补充手术。在需要再次手术的PTC患者中，如突变和融合等基因改变较为常见。
